overdose solutions 2013

OVERDOSE SOLUTIONS 2013

OVERDOSE DATA FOR ALLEGHENY COUNTY

Jennifer JanssenManager Toxicology Laboratory

Allegheny County Office of the Medical ExaminerACOME

The Overdose Problem in Allegheny County2008-2012

Allegheny CountyOverdose Prevention

Coalition

July 24, 2013

Jennifer Janssen, M.S.Allegheny County

Scope of the National Problem

• In 2007, approximately 27,000 unintentional overdose deaths occurred in the U.S., one death every 19 minutes (MMWR, January 13, 2013)

• Rate of unintentional overdose deaths in the U.S. has been steadily increasing, largely attributed to prescription drug abuse.

Rate* of unintentional drug overdose deaths — United States, 1970–2007

* Per 100,000 population

Scope of the National Problem

• Prescription drug abuse is the fastest growing drug problem in the U.S.

• Since 2003, more overdose deaths have involved opioid analgesics than heroin or cocaine combined

Unintentional Drug Overdose Deaths in U.S. during 1999-2007

Overdoses of Prescription Opioid Pain Relievers and Other Drugs Among Women –U.S., 1999-2010Reported in Morbidity and Mortality Weekly July 5, 2013

• Overdose deaths increasing steadily• In 2012, total of 15,323 deaths among women were attributed

to drug overdoses• Opiate pain reliever (OPR) deaths increased five fold between

1999 -2010 for women• OPR deaths among men increased 3.6 times• Conclusion: More men die from drug overdoses than women,

however % increase in deaths since 1999 is greater for women

Crude rates for drug overdose deaths and drug misuse-or abuse-related emergency department visit among women by select drug class

Scope of Problem in Allegheny County2012

ACOME Death Investigations: • Total Number of cases:1138• Accidental Deaths: 446 (39.1%)• Unintentional Drug Deaths: 288 (25.31%)• Unintentional Drug Deaths as % of Accidental Deaths: 64.5%

ACOME Drug Deaths as % of Morgue Cases

2012 2011 2010 2009 2008 20070.00%

5.00%

10.00%

15.00%

20.00%

25.00%

30.00%

25.31%

22.18%

19.62% 18.99%20.80%

18.70%

Drug Deaths as % of Morgue Cases

Drug Death as % All Morgue Cases

ACOME Drug Deaths as % of Accidental Deaths

2012 2011 2010 2009 2008 20070.00%

10.00%

20.00%

30.00%

40.00%

50.00%

60.00%

70.00%64.43%

60.37%58.06% 57.77% 56.63%

49.89%

Drug Deaths as % of Accidental Deaths

Drug Death as % Accidental Deaths

Drug Deaths by Age Group

ACOME Drug Deaths by Age Group

0 thru 19 20 thru 24 25 thru 29 30 thru 34 35 thru 39 40 thru 44 45 thru 49 50 thru 54 55 thru 59 60 thru 69 70 or >0.00%2.00%4.00%6.00%8.00%

10.00%12.00%14.00%16.00%18.00%20.00%

0.69%

8.33%

15.97% 16.67%

7.64% 7.29%

11.81%

17.71%

8.33%

5.21%

0.35%

2012 % of Drug Deaths per Age Group


10.00%12.00%14.00%16.00%18.00%

2.29%

6.11%

11.45%12.60% 12.21%

13.36%

16.79%

13.74%

7.25%

4.20%




10.00%12.00%14.00%16.00%18.00%20.00%

1.76%

6.61%

11.01% 10.57%8.81%

12.78%14.10%

17.18%

11.01%

4.41%1.76%



10.00%12.00%14.00%16.00%18.00%

3.14%

5.83%

11.66%

8.07%10.31%

13.45%15.25%

17.04%

10.31%

4.04%

0.90%




10.00%12.00%14.00%16.00%18.00%20.00%

2.97%

9.75% 9.32%

5.08%

8.90%

16.10%18.64%

15.68%

9.32%

2.54% 1.69%


0 thru 19 20 thru 24 25 thru 29 30 thru 34 35 thru 39 40 thru 44 45 thru 49 50 thru 54 55 thru 59 60 thru 69 70 or >0.00%

5.00%

10.00%

15.00%

20.00%

25.00%

3.13%6.25%

10.27% 10.71% 9.38%11.16%

16.07%19.20%

9.38%

3.57%0.89%


Drug Deaths by Age Group• 2008-2010 Median Age of Death: 40 years, Range: 16-88• 2011 Median Age of Death: 41.5 years, Range: 15-66• 2012 Median Age of Death: 40 years, Range: 18-75• 2011-2012 Percentage of 30-24 year olds increasingCombined the 20-34 year old categories

2007: 27.2%2008: 24.1%

2009: 25.5%2010: 28.1%2011: 30.1%2012: 40.9%

Drug Deaths by Race/Sex

ACOME Drug Deaths by Race/Sex

White Black Other0

20406080

100120140160 151

264

93

131

2012 Drug Deaths by Race / SexMale Female

White Black Other0

20406080

100120140160 152

201

76

13


ACOME Drug Deaths by Race/Sex

White Black Other0

20406080

100120140 131

28

2

57

5


White Black Other0

20406080

100120140 124

28

1

63

11


Drug Death by Race/Sex in 2012

• White males accounted for highest % of deaths (52.4%)• White females accounted for 32.2% in 2012• Number of white females increasing: 2011:29%

2010: 27%• Other races, both M and F accounted for 15.2% of deaths

ACOME Drug Deaths TotalSingle or Combined

Case Year

Total Drug Deaths

1 Drug 2 Drug 3 Drug 4 Drug 5 Drug 6 Drug 7 Drug

2012 288 111 78 59 27 11 1 1

2011 262 89 72 57 27 12 2 3

2010 227 61 69 52 28 9 1 7

2009 223 52 57 61 24 20 3 6

2008 235 81 56 58 22 13 2 3

ACOME DRUG DEATHS

• Most drug deaths involve multiple drugs (61%> 1 drug)• Single drug deaths in 2008-2010 attributed to cocaine, heroin

or alcohol• Alcohol listed on death certificate on 18-24% of drug deaths in

2008-2010• Cocaine and heroin common co intoxicants• Benzodiazepines often found with opiates

ACOME Accidental Overdose Cases

Heroin; 138

Alcohol; 72Cocaine; 67

Alprazolam; 36

Morphine; 31

Oxycodone; 31

Oxymorphone; 26Methadone; 21

2012 Top 8 Drugs FoundSingle or Combined OD

HeroinAlcoholCocaineAlprazolamMorphineOxycodoneOxymorphoneMethadone

2012 Top 8 Drugs Found

• Heroin most prevalent, identified in 47.9% of overdose deaths• Alcohol: 25.0 %• Cocaine: 23.2 %• Alprazolam: 12.5 %• Oxycodone: 10.7 %• Morphine : 10.7 %• Oxymorphone: 9.0 %• Methadone: 7.2 %• Hydrocodone (5.2%), Codeine (3.8%), and Fentanyl(4.8%) not as prevalent• Low incidence of amphetamine, methamphetamine and other designer drugs (<1%)

Misclassification of Morphine Deaths

• Heroin undergoes rapid breakdown to 6MAM and then to morphine

• Heroin has a half-life of 9 minutes, and 6 MAM 39 minutes• Morphine has a longer half-life (1.3-6.7 hours), and therefore

depending on survival time might be the only drug detected• In the absence of a drug history, stamp bags, or track marks,

some heroin deaths may be classified as morphine deaths

Top Eight Drugs Found in Overdose Deaths

Cocaine; 86

Alcohol; 56

Heroin; 50Morphine; 48

Oxycodone; 40

Alprazolam; 39

Methadone; 32

Diazepam; 20


CocaineAlcoholHeroinMorphineOxycodoneAlprazolamMethadoneDiazepam

Cocaine; 76

Heroin; 63

Alcohol; 61Morphine;

40

Alprazo-lam; 39

Methadone; 38

Oxy-codone; 33Hydrocodone; 25


CocaineHeroinAlcoholMorphineAlprazolamMethadoneOxycodoneHydrocodone

Heroin; 138

Alcohol; 72Cocaine; 67

Alprazo-lam; 36

Morphine; 31

Oxy-codone; 31

Oxymor-phone; 26Methadone; 21


HeroinAlcoholCocaineAlprazolamMorphineOxycodoneOxymorphoneMethadone

Heroin; 95

Cocaine; 83

Alcohol; 60

Oxycodone; 51

Alprazolam; 42

Methadone; 26

Diazepam; 25

Morphine; 24


HeroinCocaineAlcoholOxycodoneAlprazolamMethadoneDiazepamMorphine

Heroin: bricks, bundles, stamp bags…

Summary

• Heroin is responsible for greatest percentage of overdose deaths in Allegheny County

• Oxycodone and oxymorphone identified in 19.7% of overdose deaths

• The number of overdose deaths in the 20-34 year old age category increasing

• Pittsburgh has a “traditional pattern” of drug use

Acknowledgements

• Kristen Mertz, MD, MPH – Department of epidemiology/GSPH/University of Pittsburgh

• Patricia Rekiel – Computer Analyst, ACOME• Karl Williams, MD, MPH,Chief Medical Examiner, ACOME

overdose solutions 2013

Documents

unintentional drug deaths

racesexacome drug deaths

drugsingle drug deaths

age groupacome drug

womenopr deaths

morgue casesacome drug

drug misuse

age groupdrug deaths